New meta-analysis on statin use in elderly
Primary Prevention With Statin Therapy in the Elderly: New Meta-Analyses from the Contemporary JUPITER and HOPE-3 Randomized TrialsLiterature - Ridker PM, Lonn E, Paynter NP, et al. - Circulation. 2017; published online ahead of print
In primary prevention, the role for statin therapy in the elderly is uncertain, according to current cardiovascular (CV) guidelines . Regarding all age categories, rosuvastatin therapy was associated with a 47% risk reduction of nonfatal myocardial infarction (MI), nonfatal stroke or CV death in the primary prevention JUPITER study, and with a 20% reduction of all-cause mortality . Moreover, the HOPE-3 study showed a 24% risk reduction of nonfatal MI, nonfatal stroke or CV death with rosuvastatin and a 7% non-significant reduction of all-cause mortality .
In this meta-analysis of JUPITER and HOPE-3 trials, the age-specific outcome data from the elderly subgroups (<65, 65-70 and >70 years) were analysed.
- In JUPITER, 5,695 participants were 70 or older, and the rates of drug withdrawal in the rosuvastatin groups were 14.3%, 17.0% and 21.6% in patients aged <65, 65-70 and >70, respectively.
- The elderly participants represented 32% of the total JUPITER population and suffered 55% of all the hard CV disease events in the trial.
- There was a 39% risk reduction for the combined CV endpoint (HR 0.61, 95% CI 0.43-0.86, P=0.004) and a non-significant 20% risk reduction of all-cause mortality in the JUPITER elderly subgroups (HR 0.80, 95% CI 0.62-1.04, P=0.09).
- In the HOPE-3 study, 3,086 participants were 70 or older, they represented 24% of the total trial population and they suffered 43% of all the hard CV disease events.
- In HOPE-3, rates of drug withdrawal in the rosuvastatin groups were 21.4%, 23.1% and 29.1% in patients aged <65, 65-70 and >70, respectively.
- There was a non-significant 17% risk reduction for the combined CV endpoint (HR 0.83, 95% CI 0.64-1.07, P=0.16) and a non-significant 9% risk reduction of all-cause mortality (HR 0.91, 95% CI 0.73-1.13, P=0.38).
- In the meta-analysis, a 26% relative risk reduction was observed for individuals >70 years for the endpoint of nonfatal MI, nonfatal stroke or CV death (HR 0.74, 95% CI 0.61-0.91, P=0.0048).
- For the expanded endpoint that also included revascularisation, results were similar (HR 0.74, 95% CI 0.61- 0.89, P=0.0016).
The meta-analysis of elderly subgroup data in the JUPITER and HOPE-3 studies provide some insights in statin use for the primary prevention of the elderly, however, it also leaves critical questions unanswered that are relevant for clinical practice. For example, benefits should be weighed against the potential for a modest impact on longevity and personal preferences must be taken into account, although benefits are consistent above and below the age of 70.